Treatments expanded for clot retrieval, pain relief, and more

The latest updates to the Australian and New Zealand living stroke guidelines include expanded the benefit of endovascular clot retrieval (ECR) within 24 hours after the onset of ischaemic stroke caused by blockages in major brain arteries.

Members of the guidelines' Content Development Group also agreed that ECR can be considered beyond 24 hours, depending on whether imaging suggests there is salvageable brain tissue.

Additionally, re-established recommendations in the guidelines cover central post-stroke pain, a potentially debilitating condition where people feel pain in parts of their body corresponding to the area of brain damaged by their stroke. Although more research is needed, the Content Development Group agreed that medications such as tricyclic antidepressants or antiepileptics can be trialled to reduce the pain.

These and other updates were approved by the National Health and Medical Research Council (NHMRC) on 27 July 2023, following public consultation earlier this year.

Updates include a change to the threshold for starting oxygen therapy in acute stroke, as well as the target oxygen saturation, aligning the stroke guidelines with the latest position statement from the Thoracic Society of Australia and New Zealand.

Recommendations for driving after stroke or transient ischaemic attack have also been brought into line with the new edition of Assessing Fitness to Drive by Austroads, and the Medical Aspects of Fitness to Drive by Waka Kotahi NZ Transport Agency.

The NHMRC noted an upgrade in strength from weak to strong of the recommendation for swallowing screening by a trained healthcare professional using a validated tool. New evidence of a consistent association of screening with reduced pneumonia risk warranted an upgrade under the GRADE process. However with no change in the wording of the recommendation, public consultation was not required.

The Clinical Guidelines for Stroke Management continue to follow a living evidence approach, where monthly searches for new research evidence feed into 6-monthly reviews and updates where appropriate.